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Healthcare Career Observation Application

McLaren Northern Michigan
Healthcare Career Observation Application for students 17 years of age and older

Note: Fields marked with an * indicates required field

(Please Note: Healthcare career observation will be offered based on department and resource availability and will not be available in the Emergency Department, Surgery, Recovery, Procedural Areas, ICU and Labor and Delivery.)

Local person to be contacted in case of illness/emergency:

I have read and understand the information on the Information Sheet below. Should I need medical attention during or as a result of this healthcare career observation experience, I assume full responsibility for any treatments deemed necessary. I assume responsibility of all medical costs which result and release McLaren Northern Michigan of all liability. I give the facility at which the healthcare career observation is being conducted permission to release my telephone number or contact instructions to the requested department. While I am healthcare career observation at any site under McLaren Northern Michigan, I realize that all health care information, patient / resident care and records are a confidential matter. All information exchanged while I am observing must be held in the strictest confidence.

My typed name below shall have the same force and effect as my written signature.

If Applicant is under the age of 18; I have read and understand the information at the top of the application and authorize my son/daughter to participate in this volunteer experience. McLaren-Northern Michigan shall not be held responsible for adverse occurrences and/or outcomes. Should my child need medical attention during or as a result of this volunteer experience, I authorize such medical care and assume full responsibility for any treatments deemed necessary. I assume responsibility for all medical costs which result and release McLaren-Northern Michigan of all liability. I give McLaren-Northern Michigan permission to release my son/daughter telephone number or contact information to the requested department. My typed name below shall have the same force and effect as my written signature.

Please read the following information prior to submitting your application:

General Information

1. Healthcare career observation is an opportunity to observe an employee. Healthcare career observation participants are not permitted to provide any aspect of patient care.
2. Healthcare career observation experience may be scheduled for 3-4 hours during daytime hours.
3. If you are unable to report for your scheduled healthcare career observation experience, please notify Susan Stout, RN, MS, Manager of Volunteer Services, by email or 231.487.4111.

Infection Control

Proper hand hygiene helps prevent the spread of infections from one person to another. Hand hygiene products, which contain a special antibacterial agent, are available in wall dispensers in the work areas and cafeteria.

Hazardous Materials

Potentially hazardous chemicals and materials are used in certain areas as part of the daily operation of a department. Material Safety Data Sheets (MSDS) which describe the hazard and handling instructions for all chemical products are available for your review on request.

Tobacco Free Campus

Smoking and all tobacco products are prohibited in all McLaren Northern Michigan facilities and its adjacent grounds.

Dress Code

Please adhere to the following dress code, unless otherwise directed:

- Comfortable closed-toe shoes with socks or hose, no bare legs
- Shirt (no slogans) with slacks or skirt (no jeans, sagging pants, t-shirts, low-cut or midriff-baring shirts; skirts may not be more than 2” above knee)
- Minimum jewelry (no facial piercing jewelry), no visible tattoos
- Minimum make-up
- No fragrance or smoking odor on clothing Well-groomed hair Health Requirements

You must be in good health without fever (99.0 or less) and/or symptoms of cold, flu or other illness. Confidentiality Please read and sign the attached confidentiality agreement.

Statement of Confidentiality

Each of our patients and employees has the right to expect that we will keep any knowledge we have about them in the strictest confidence. It is our obligation under the law and the codes, regulations and certifications under which we operate, to honor this expectation. Equally important, respecting confidentiality is part of our obligation to provide the most comfortable and caring environment for our patients.

We live at a time when personal information is recorded in many forms. It may be on paper, but it may also be found on a computer screen, voice mail, cellular telephones or another modern convenience. This data is all subject to the same rules.

Our expectation is that you will keep all patient and employee information to yourself or share it only with others who have a work related or legal right to know. You should never share any information with anyone else, including spouses or coworkers. Passwords, to access patient and employee information, must not be shared.

Finally, we remind you that the organization will not tolerate violations of this standard. The established rules call for prompt and severe discipline for a breach of confidentiality. Please understand that the Confidentiality of Health and Medical Record Information policy RI.108 will be strictly enforced.

My typed name below shall have the same force and effect as my written signature.

Authorization and Release

In connection with my opportunity to participate in any program affiliated with McLaren Northern Michigan, I understand that information may be requested as to my character and other personal history. I further understand that you will be requesting information regarding my criminal history and other public records. I agree that any false information may subject me to removal from programs at McLaren Northern Michigan. It is the policy of McLaren Northern Michigan not to employ or retain persons in positions of trust who have demonstrated a propensity to engage in illegal activities.

I hereby authorize and release from all liability without reservation, McLaren Northern Michigan and any law enforcement agency, administrator, state/federal agency, institution, insurance company, or person gathering or furnishing the above information.